Hospital

BRYAN MEDICAL CENTER

Lincoln, NE · CCN 280003 · Rates published

15,783 distinct procedures filed

11 distinct payers

116,942 rate rows

2026-07-18 last MRF observed

Data quality

116,431 of 116,942 rate rows are consumer-grade (99.6%)

511 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
exceeds 10× this hospital's gross charge — excluded from medians	479
placeholder amount (≤ $0.02) — excluded from medians	15
exceeds 3× this hospital's gross charge for a DRG stay — excluded	8
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	6
per-diem day rate — not a per-procedure price	3

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://www.bryanhealth.com/app/files/public/0c8f55af-3354-471c-9d96-e1d3c2e2a445/470376552_bryan-medical-center_standardcharges.csv
Found on page	https://www.bryanhealth.com/patients-visitors/pricing-insurance-financial-assistance-billing/price-estimates/
Discovered via	Discovered by HANK
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-09-21
Content fingerprint	0417c71779047805… · 23,324,872 bytes · first seen 2026-05-05

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code	Description	Payers	Min $	Max $	Avg median	vs national
0773 OTHER	Inj, Beqvez, Per Tx Dose	2	$3,615,617.60	$3,615,617.60	$3,615,617.60	—
9138 OTHER	Inj, Hemgenix, Per Tx Dose	2	$3,615,617.60	$3,615,617.60	$3,615,617.60	nat. median $3,765,001 1.0× median
0714 OTHER	Inj Delandistrogene Mox Rokl	2	$3,237,275.39	$3,237,275.39	$3,237,275.39	nat. median $4,693,518 0.7× median
0748 OTHER	Inj, Lovotibeglogene Autotem	2	$3,111,770.08	$3,111,770.08	$3,111,770.08	—
0746 OTHER	Inj, Betibeglogene Autotemce	2	$2,892,494.08	$2,892,494.08	$2,892,494.08	—
9141 OTHER	Inj Onase Abepar-xioi Treat	2	$2,342,314.76	$2,342,314.76	$2,342,314.76	nat. median $2,508,045 0.9× median
0824 RC	Inj, Exagamglogene Autotem	2	$2,272,673.92	$2,272,673.92	$2,272,673.92	nat. median $1,136 outlier · 1999.7×
9194 OTHER	Tisagenlecleucel Car-pos T	2	$551,234.37	$551,234.37	$551,234.37	nat. median $555,653 1.0× median
583 - 4 OTHER	Neonate With Ecmo	4	$472,816.54	$774,455.49	$548,226.28	—
11 - 4 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	4	$270,719.54	$1,355,897.38	$542,014.00	—
9498 OTHER	Ciltacabtagene Car-pos T	2	$537,292.80	$537,292.80	$537,292.80	nat. median $553,480 1.0× median
9422 OTHER	Idecabtagene Vicleucel Car	2	$514,872.16	$514,872.16	$514,872.16	nat. median $552,917 0.9× median
9413 OTHER	Lisocabtagene Mara Car Pos T	2	$503,346.57	$503,346.57	$503,346.57	nat. median $542,562 0.9× median
9035 OTHER	Axicabtagene Ciloleucel Car+	2	$477,063.83	$477,063.83	$477,063.83	nat. median $513,929 0.9× median
9391 OTHER	Brexucabtagene Car Pos T	2	$475,635.48	$475,635.48	$475,635.48	nat. median $483,557 1.0× median
11 - 3 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	4	$201,473.27	$1,250,109.90	$463,632.43	—
2 - 4 OTHER	Heart And/or Lung Transplant	4	$270,540.72	$854,611.48	$416,558.41	—
583 - 3 OTHER	Neonate With Ecmo	4	$269,284.70	$767,167.94	$393,755.51	—
588 - 4 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$289,591.51	$688,447.48	$389,305.50	—
11 - 2 OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	4	$160,168.32	$892,954.68	$343,364.91	—
161 - 4 OTHER	Implantable Heart Assist Systems	4	$201,889.94	$612,198.29	$304,467.03	—
583 - 2 OTHER	Neonate With Ecmo	4	$206,760.87	$481,415.24	$275,424.46	—
609 - 4 OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	4	$201,765.88	$496,146.98	$275,361.16	—
1 - 4 OTHER	Liver Transplant And/or Intestinal Transplant	4	$150,589.02	$584,528.06	$259,073.78	—
588 - 3 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$192,867.64	$421,415.15	$250,004.52	—
591 - 4 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	4	$189,899.56	$412,862.74	$245,640.36	—
841 - 4 OTHER	Extensive Third Degree Burns With Skin Graft	4	$179,586.16	$435,265.46	$243,505.98	—
593 - 4 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	4	$166,958.36	$430,573.09	$232,862.04	—
631 - 4 OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	4	$194,062.06	$340,625.56	$230,702.93	—
583 - 1 OTHER	Neonate With Ecmo	4	$185,593.33	$361,417.39	$229,549.35	—
9 - 4 OTHER	Extracorporeal Membrane Oxygenation (ecmo)	4	$197,917.39	$318,344.42	$228,024.15	—
588 - 2 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$165,266.84	$410,206.78	$226,501.83	—
161 - 3 OTHER	Implantable Heart Assist Systems	4	$158,084.08	$416,858.39	$222,777.66	—
7 - 4 OTHER	Allogeneic Bone Marrow Transplant	4	$159,283.63	$400,144.02	$219,498.73	—
2 - 3 OTHER	Heart And/or Lung Transplant	4	$147,367.69	$430,325.27	$218,107.08	—
J1823 HCPCS	Inebilizumab-cdon 10 Mg/ml IV Soln\|discarded Drug Not Administered	6	$99,109.00	$471,303.98	$206,476.69	nat. median $562 outlier · 367.2×
630 - 4 OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	4	$175,994.35	$291,377.93	$204,840.24	—
4 - 4 OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	4	$152,101.72	$320,168.06	$194,118.30	—
1 MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	2	$192,644.09	$192,644.09	$192,644.09	nat. median $186,516 1.0× median
589 - 1 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	4	$134,989.72	$324,350.74	$182,329.98	—
J3316 HCPCS	Triptorelin Pamoate(pediatric) 22.5 Mg IM Susr\|discarded Drug Not Administered	6	$91,614.64	$408,687.54	$181,226.56	nat. median $4,480 outlier · 40.4×
161 - 2 OTHER	Implantable Heart Assist Systems	4	$116,318.82	$368,279.42	$179,308.97	—
593 - 3 OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	4	$122,135.19	$333,471.28	$174,969.21	—
161 - 1 OTHER	Implantable Heart Assist Systems	4	$116,318.82	$350,288.51	$174,811.24	—
J2351 HCPCS	Ocrelizumab-hyaluronidase-ocsq 920 Mg-23,000 Unit/23 Ml Subq Soln\|discarded Drug…	6	$86,908.72	$416,190.80	$174,590.11	nat. median $56 outlier · 3104.9×
588 - 1 OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	$141,657.41	$272,832.91	$174,451.29	—
591 - 3 OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	4	$143,217.17	$245,309.97	$168,740.37	—
1 - 3 OTHER	Liver Transplant And/or Intestinal Transplant	4	$78,182.16	$430,867.68	$166,353.54	—
602 - 4 OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	4	$125,775.77	$285,455.77	$165,695.77	—
589 - 2 OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational…	4	$134,989.72	$236,219.83	$160,297.25	—

Other procedures at this hospital

Browse this hospital's 15,783 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

690 - 4	OTHER	Acute Leukemia	4	4	—	—	$50,529.17	$161,378.11	$78,241.40	2026-07-18
690 - 3	OTHER	Acute Leukemia	4	4	—	—	$34,133.31	$97,071.42	$49,867.84	2026-07-18
850	MS_DRG	Acute Leukemia With Other Procedures	2	2	$320,940.79	—	$59,527.81	$59,527.81	$59,527.81	2026-07-18
401 - 4	OTHER	Adrenal Procedures	4	4	—	—	$43,471.32	$121,608.73	$63,005.67	2026-07-18
J0202	HCPCS	Alemtuzumab 12 Mg/1.2 Ml IV Soln\|discarded Drug Not Administered	14	6	$93,423.54	$56,054.12 40% off	$58,317.38	$279,989.78	$122,174.89	2026-07-18
7 - 4	OTHER	Allogeneic Bone Marrow Transplant	4	4	—	—	$159,283.63	$400,144.02	$219,498.73	2026-07-18
7 - 3	OTHER	Allogeneic Bone Marrow Transplant	4	4	—	—	$101,306.46	$334,528.05	$159,611.86	2026-07-18
7 - 2	OTHER	Allogeneic Bone Marrow Transplant	4	4	—	—	$71,340.78	$290,959.42	$126,245.44	2026-07-18
7 - 1	OTHER	Allogeneic Bone Marrow Transplant	4	4	—	—	$62,975.58	$135,358.51	$81,071.31	2026-07-18
268	MS_DRG	Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc	2	2	$177,665.48	—	$47,280.60	$47,280.60	$47,280.60	2026-07-18
8 - 4	OTHER	Autologous Bone Marrow Transplant	4	4	—	—	$70,844.54	$247,624.59	$115,039.55	2026-07-18
8 - 3	OTHER	Autologous Bone Marrow Transplant	4	4	—	—	$49,863.51	$195,604.09	$86,298.65	2026-07-18
8 - 2	OTHER	Autologous Bone Marrow Transplant	4	4	—	—	$39,137.71	$121,087.36	$59,625.12	2026-07-18
9035	OTHER	Axicabtagene Ciloleucel Car+	2	2	—	—	$477,063.83	$477,063.83	$477,063.83	2026-07-18
9391	OTHER	Brexucabtagene Car Pos T	2	2	—	—	$475,635.48	$475,635.48	$475,635.48	2026-07-18
842 - 4	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	4	4	—	—	$100,542.41	$210,043.58	$127,917.70	2026-07-18
842 - 3	OTHER	Burns With Skin Graft Except Extensive Third Degree Burns	4	4	—	—	$40,611.91	$93,555.07	$53,847.70	2026-07-18
J0638	HCPCS	Canakinumab (pf) 150 Mg/ml Subq Soln\|discarded Drug Not Administered	14	6	$67,989.78	$40,793.87 40% off	$42,481.20	$203,902.01	$88,047.05	2026-07-18
120	EAPG	Car T-cell Immunotherapy	4	4	—	—	$65,239.56	$68,759.98	$66,119.66	2026-07-18
275	MS_DRG	Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc	2	2	$167,556.14	—	$49,016.36	$49,016.36	$49,016.36	2026-07-18
216	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	2	2	$255,115.35	—	$67,249.69	$67,249.69	$67,249.69	2026-07-18
217	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza…	2	2	$207,065.04	—	$45,200.44	$45,200.44	$45,200.44	2026-07-18
219	MS_DRG	Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter…	2	2	$202,026.13	—	$52,782.77	$52,782.77	$52,782.77	2026-07-18
162 - 4	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	4	4	—	—	$77,886.12	$201,750.70	$108,852.26	2026-07-18
162 - 3	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	4	4	—	—	$56,973.55	$134,937.67	$76,464.58	2026-07-18
162 - 2	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	4	4	—	—	$43,072.62	$118,115.76	$61,833.40	2026-07-18
162 - 1	OTHER	Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis	4	4	—	—	$35,890.71	$100,454.51	$52,031.66	2026-07-18
163 - 4	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	4	4	—	—	$68,153.67	$125,153.14	$82,403.54	2026-07-18
163 - 3	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	4	4	—	—	$48,995.93	$94,237.77	$60,306.39	2026-07-18
163 - 2	OTHER	Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis	4	4	—	—	$36,161.08	$76,050.46	$46,133.43	2026-07-18
SUP-431937	CDM	Cath Impella 5.5 S2 W Smart Assist	6	6	$79,200.00	$47,520.00 40% off	$15,048.00	$118,800.00	$45,262.80	2026-07-18
695 - 4	OTHER	Chemotherapy For Acute Leukemia	4	4	—	—	$46,506.14	$118,697.92	$64,554.08	2026-07-18
11 - 4	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	4	4	—	—	$270,719.54	$1,355,897.38	$542,014.00	2026-07-18
11 - 3	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	4	4	—	—	$201,473.27	$1,250,109.90	$463,632.43	2026-07-18
11 - 2	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	4	4	—	—	$160,168.32	$892,954.68	$343,364.91	2026-07-18
11 - 1	OTHER	Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies	4	4	—	—	$78,883.75	$83,216.43	$79,966.92	2026-07-18
9498	OTHER	Ciltacabtagene Car-pos T	2	2	—	—	$537,292.80	$537,292.80	$537,292.80	2026-07-18
246	EAPG	Class IV Therapeutic Radiopharmaceuticals	4	4	—	—	$52,343.27	$58,451.73	$53,870.39	2026-07-18
429	MS_DRG	Combined Anterior And Posterior Cervical Spinal Fusion With Mcc	2	2	$343,184.18	—	$61,934.50	$61,934.50	$61,934.50	2026-07-18
317	MS_DRG	Concomitant Left Atrial Appendage Closure And Cardiac Ablation	2	2	$196,276.90	—	$45,964.86	$45,964.86	$45,964.86	2026-07-18
165 - 4	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	4	4	—	—	$61,229.30	$127,883.92	$77,892.96	2026-07-18
165 - 3	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	4	4	—	—	$45,500.81	$96,624.86	$58,281.82	2026-07-18
165 - 2	OTHER	Coronary Bypass With Ami Or Complex Principal Diagnosis	4	4	—	—	$36,687.27	$80,347.71	$47,602.38	2026-07-18
233	MS_DRG	Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc	2	2	$204,664.05	—	$52,555.23	$52,555.23	$52,555.23	2026-07-18
166 - 4	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	4	4	—	—	$54,585.57	$124,468.11	$72,056.21	2026-07-18
166 - 3	OTHER	Coronary Bypass Without Ami Or Complex Principal Diagnosis	4	4	—	—	$40,046.36	$85,795.25	$51,483.58	2026-07-18
910 - 4	OTHER	Craniotomy For Multiple Significant Trauma	4	4	—	—	$58,156.84	$117,652.84	$73,030.84	2026-07-18
910 - 3	OTHER	Craniotomy For Multiple Significant Trauma	4	4	—	—	$37,541.16	$80,027.40	$48,162.72	2026-07-18
955	MS_DRG	Craniotomy For Multiple Significant Trauma	2	2	$138,908.06	—	$43,922.77	$46,271.46	$45,097.11	2026-07-18
179 - 4	OTHER	Defibrillator Implants	4	4	—	—	$53,873.71	$144,892.87	$76,628.50	2026-07-18
179 - 3	OTHER	Defibrillator Implants	4	4	—	—	$41,026.88	$89,793.23	$53,218.47	2026-07-18
304 - 4	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	4	4	—	—	$54,663.43	$129,590.66	$73,395.24	2026-07-18
304 - 3	OTHER	Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back	4	4	—	—	$40,297.90	$92,182.66	$53,269.09	2026-07-18
303 - 4	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	4	4	—	—	$77,509.66	$185,646.55	$104,543.88	2026-07-18
303 - 3	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	4	4	—	—	$53,791.57	$121,891.63	$70,816.59	2026-07-18
303 - 2	OTHER	Dorsal And Lumbar Fusion Procedure For Curvature Of Back	4	4	—	—	$39,122.31	$88,451.22	$51,454.54	2026-07-18
3	MS_DRG	Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth…	2	2	$504,792.82	—	$145,907.94	$145,907.94	$145,907.94	2026-07-18
J9334	HCPCS	Efgartigimod-hyaluronidas-qvfc 1,008 Mg-11,200 Unit/5.6 Ml Subq Soln\|discarded D…	14	6	$55,183.47	$33,110.08 40% off	$34,159.10	$165,483.07	$72,263.95	2026-07-18
911 - 4	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	4	4	—	—	$55,315.40	$187,311.21	$88,314.35	2026-07-18
911 - 3	OTHER	Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma	4	4	—	—	$32,009.71	$87,539.40	$45,892.13	2026-07-18
950 - 4	OTHER	Extensive O.r. Procedure Unrelated To Principal Diagnosis	4	4	—	—	$45,680.48	$240,750.87	$94,448.08	2026-07-18
792 - 4	OTHER	Extensive O.r. Procedures For Other Complications Of Treatment	4	4	—	—	$41,028.59	$116,472.15	$59,889.48	2026-07-18
841 - 4	OTHER	Extensive Third Degree Burns With Skin Graft	4	4	—	—	$179,586.16	$435,265.46	$243,505.98	2026-07-18
841 - 3	OTHER	Extensive Third Degree Burns With Skin Graft	4	4	—	—	$58,404.11	$143,080.92	$79,573.31	2026-07-18
178 - 4	OTHER	External Heart Assist Systems	4	4	—	—	$64,808.28	$250,348.36	$111,193.30	2026-07-18
178 - 3	OTHER	External Heart Assist Systems	4	4	—	—	$52,293.42	$136,983.42	$73,465.92	2026-07-18
178 - 2	OTHER	External Heart Assist Systems	4	4	—	—	$42,578.08	$130,656.79	$64,597.76	2026-07-18
178 - 1	OTHER	External Heart Assist Systems	4	4	—	—	$38,319.76	$119,446.08	$58,601.34	2026-07-18
9 - 4	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	4	4	—	—	$197,917.39	$318,344.42	$228,024.15	2026-07-18
9 - 3	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	4	4	—	—	$133,013.29	$227,153.07	$156,548.23	2026-07-18
9 - 2	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	4	4	—	—	$66,759.05	$96,790.86	$74,267.00	2026-07-18
9 - 1	OTHER	Extracorporeal Membrane Oxygenation (ecmo)	4	4	—	—	$48,886.42	$91,951.20	$59,652.61	2026-07-18
92 - 4	OTHER	Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures	4	4	—	—	$43,829.82	$99,224.72	$57,678.54	2026-07-18
514 - 4	OTHER	Female Reproductive System Reconstructive Procedures	4	4	—	—	$35,089.01	$101,749.76	$51,754.20	2026-07-18
928	MS_DRG	Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc	2	2	$47,617.35	—	$49,307.14	$49,307.14	$49,307.14	2026-07-18
232 - 4	OTHER	Gastric Fundoplication	4	4	—	—	$33,185.30	$111,863.95	$52,854.96	2026-07-18
851 - 4	OTHER	Gender Related Procedures	4	4	—	—	$92,776.13	$209,159.82	$121,872.05	2026-07-18
851 - 3	OTHER	Gender Related Procedures	4	4	—	—	$67,937.60	$92,776.13	$86,566.50	2026-07-18
428 - 4	OTHER	Genetic Disorders	3	3	—	—	$45,872.14	$45,872.14	$45,872.14	2026-07-18
C9293	HCPCS	Glucarpidase 1000 Units IV Solr	5	5	$117,179.45	$70,307.67 40% off	$22,264.10	$175,769.17	$70,987.31	2026-07-18
J1628	HCPCS	Guselkumab 100 Mg/ml Subq Syrg\|discarded Drug Not Administered	16	7	$48,988.33	$29,393.00 40% off	$15,194.40	$146,897.65	$48,650.57	2026-07-18
2 - 4	OTHER	Heart And/or Lung Transplant	4	4	—	—	$270,540.72	$854,611.48	$416,558.41	2026-07-18
2 - 3	OTHER	Heart And/or Lung Transplant	4	4	—	—	$147,367.69	$430,325.27	$218,107.08	2026-07-18
2 - 2	OTHER	Heart And/or Lung Transplant	4	4	—	—	$111,592.49	$267,443.82	$150,555.32	2026-07-18
2 - 1	OTHER	Heart And/or Lung Transplant	4	4	—	—	$98,630.15	$219,865.52	$128,938.99	2026-07-18
1	MS_DRG	Heart Transplant Or Implant Of Heart Assist System With Mcc	2	2	$759,540.13	—	$192,644.09	$192,644.09	$192,644.09	2026-07-18
SUP-421192	CDM	Heartmate 3 Lvas Implant Kit	6	6	$179,865.00	$107,919.00 40% off	$34,174.35	$269,797.50	$102,792.85	2026-07-18
227 - 4	OTHER	Hernia Procedures Except Inguinal, Femoral And Umbilical	4	4	—	—	$33,165.62	$90,985.61	$47,620.62	2026-07-18
890 - 4	OTHER	HIV With Multiple Major HIV Related Conditions	4	4	—	—	$29,277.78	$100,660.25	$47,123.40	2026-07-18
J3424	HCPCS	Hydroxocobalamin 5 G IV Solr	7	6	$3,398.17	$2,038.90 40% off	$645.65	$518,494.82	$149,611.81	2026-07-18
9422	OTHER	Idecabtagene Vicleucel Car	2	2	—	—	$514,872.16	$514,872.16	$514,872.16	2026-07-18
161 - 4	OTHER	Implantable Heart Assist Systems	4	4	—	—	$201,889.94	$612,198.29	$304,467.03	2026-07-18
161 - 3	OTHER	Implantable Heart Assist Systems	4	4	—	—	$158,084.08	$416,858.39	$222,777.66	2026-07-18
161 - 2	OTHER	Implantable Heart Assist Systems	4	4	—	—	$116,318.82	$368,279.42	$179,308.97	2026-07-18
161 - 1	OTHER	Implantable Heart Assist Systems	4	4	—	—	$116,318.82	$350,288.51	$174,811.24	2026-07-18
J1823	HCPCS	Inebilizumab-cdon 10 Mg/ml IV Soln\|discarded Drug Not Administered	14	6	$157,123.77	$94,274.26 40% off	$99,109.00	$471,303.98	$206,476.69	2026-07-18
710 - 4	OTHER	Infectious And Parasitic Diseases Including HIV With O.r. Procedure	4	4	—	—	$38,809.16	$110,475.18	$56,725.67	2026-07-18
0714	OTHER	Inj Delandistrogene Mox Rokl	2	2	—	—	$3,237,275.39	$3,237,275.39	$3,237,275.39	2026-07-18
9141	OTHER	Inj Onase Abepar-xioi Treat	2	2	—	—	$2,342,314.76	$2,342,314.76	$2,342,314.76	2026-07-18
0773	OTHER	Inj, Beqvez, Per Tx Dose	2	2	—	—	$3,615,617.60	$3,615,617.60	$3,615,617.60	2026-07-18
0746	OTHER	Inj, Betibeglogene Autotemce	2	2	—	—	$2,892,494.08	$2,892,494.08	$2,892,494.08	2026-07-18
0824	RC	Inj, Exagamglogene Autotem	2	2	—	—	$2,272,673.92	$2,272,673.92	$2,272,673.92	2026-07-18
9138	OTHER	Inj, Hemgenix, Per Tx Dose	2	2	—	—	$3,615,617.60	$3,615,617.60	$3,615,617.60	2026-07-18
0748	OTHER	Inj, Lovotibeglogene Autotem	2	2	—	—	$3,111,770.08	$3,111,770.08	$3,111,770.08	2026-07-18
176 - 4	OTHER	Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices	4	4	—	—	$38,650.87	$122,015.54	$59,492.04	2026-07-18
33276	CPT	Insj Phrnc Nrv Stim Sys	9	7	$89,960.00	$53,976.00 40% off	$4,100.00	$134,940.00	$48,174.38	2026-07-18
0717	OTHER	Instill Adstiladrin, Tx Dose	2	2	—	—	$61,789.09	$61,789.09	$61,789.09	2026-07-18
20	MS_DRG	Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc	2	2	$101,942.37	—	$54,092.32	$54,092.32	$54,092.32	2026-07-18
442 - 4	OTHER	Kidney And Urinary Tract Procedures For Malignancy	4	4	—	—	$36,481.07	$119,041.61	$57,121.21	2026-07-18
440 - 4	OTHER	Kidney Transplant	4	4	—	—	$76,265.62	$392,531.50	$155,332.09	2026-07-18
440 - 3	OTHER	Kidney Transplant	4	4	—	—	$51,851.93	$245,284.26	$100,210.01	2026-07-18
440 - 2	OTHER	Kidney Transplant	4	4	—	—	$44,188.32	$217,670.14	$87,558.77	2026-07-18
440 - 1	OTHER	Kidney Transplant	4	4	—	—	$41,352.86	$116,098.07	$60,039.16	2026-07-18
C1831	HCPCS	Kit Implants Aprevo 3-level	4	4	$68,400.00	$41,040.00 40% off	$27,360.00	$102,600.00	$52,137.90	2026-07-18
SUP-477330	CDM	Kit Implants Aprevo 4-level	6	6	$79,200.00	$47,520.00 40% off	$15,048.00	$118,800.00	$45,262.80	2026-07-18
SUP-477331	CDM	Kit Implants Aprevo 5-level	6	6	$90,000.00	$54,000.00 40% off	$17,100.00	$135,000.00	$51,435.00	2026-07-18
9413	OTHER	Lisocabtagene Mara Car Pos T	2	2	—	—	$503,346.57	$503,346.57	$503,346.57	2026-07-18
1 - 4	OTHER	Liver Transplant And/or Intestinal Transplant	4	4	—	—	$150,589.02	$584,528.06	$259,073.78	2026-07-18
1 - 3	OTHER	Liver Transplant And/or Intestinal Transplant	4	4	—	—	$78,182.16	$430,867.68	$166,353.54	2026-07-18
1 - 2	OTHER	Liver Transplant And/or Intestinal Transplant	4	4	—	—	$60,419.91	$174,933.84	$89,048.39	2026-07-18
1 - 1	OTHER	Liver Transplant And/or Intestinal Transplant	4	4	—	—	$53,080.57	$155,916.54	$78,789.56	2026-07-18
181 - 4	OTHER	Lower Extremity Arterial Procedures	4	4	—	—	$40,052.35	$112,371.29	$58,132.08	2026-07-18
169 - 4	OTHER	Major Abdominal Vascular Procedures	4	4	—	—	$48,666.53	$103,133.86	$62,283.36	2026-07-18
261 - 4	OTHER	Major Biliary Tract Procedures	4	4	—	—	$45,687.33	$128,632.08	$66,423.52	2026-07-18
441 - 4	OTHER	Major Bladder Procedures	4	4	—	—	$42,874.12	$125,118.07	$63,435.11	2026-07-18
160 - 4	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	4	4	—	—	$115,895.30	$241,973.65	$147,414.89	2026-07-18
160 - 3	OTHER	Major Cardiothoracic Repair Of Heart Anomaly	4	4	—	—	$53,717.13	$74,079.53	$58,807.73	2026-07-18
89 - 4	OTHER	Major Cranial Or Facial Bone Procedures	4	4	—	—	$45,979.09	$134,890.91	$68,207.04	2026-07-18
231 - 4	OTHER	Major Large Bowel Procedures	4	4	—	—	$34,840.89	$87,387.43	$47,977.53	2026-07-18
480 - 4	OTHER	Major Male Pelvic Procedures	1	1	—	—	$94,158.27	$94,158.27	$94,158.27	2026-07-18
480 - 3	OTHER	Major Male Pelvic Procedures	1	1	—	—	$49,376.22	$49,376.22	$49,376.22	2026-07-18
680 - 4	OTHER	Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	4	4	—	—	$56,528.64	$141,785.67	$77,842.90	2026-07-18
260 - 4	OTHER	Major Pancreas, Liver And Shunt Procedures	4	4	—	—	$49,135.40	$157,436.24	$76,210.61	2026-07-18
120 - 4	OTHER	Major Respiratory And Chest Procedures	4	4	—	—	$47,370.29	$123,228.97	$66,334.96	2026-07-18
230 - 4	OTHER	Major Small Bowel Procedures	4	4	—	—	$39,468.83	$99,956.51	$54,590.75	2026-07-18
220 - 4	OTHER	Major Stomach, Esophageal And Duodenal Procedures	4	4	—	—	$46,658.43	$145,930.95	$71,476.56	2026-07-18
740 - 4	OTHER	Mental Illness Diagnosis With O.r. Procedure	4	4	—	—	$47,886.22	$123,053.62	$66,678.07	2026-07-18
951 - 4	OTHER	Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis	4	4	—	—	$35,817.98	$214,415.64	$80,467.40	2026-07-18
J9350	HCPCS	Mosunetuzumab-axgb 1 Mg/ml IV Soln\|discarded Drug Not Administered	12	5	$2,243.58	$1,346.15 40% off	$40,587.00	$191,802.06	$87,857.24	2026-07-18
299 - 4	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical	3	3	—	—	$66,778.72	$66,778.72	$66,778.72	2026-07-18
299 - 3	OTHER	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical	3	3	—	—	$52,218.12	$52,218.12	$52,218.12	2026-07-18
426	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	2	2	$238,294.98	—	$75,762.80	$75,762.80	$75,762.80	2026-07-18
427	MS_DRG	Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Wit…	2	2	$171,131.79	—	$49,622.67	$49,622.67	$49,622.67	2026-07-18
447	MS_DRG	Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-made Anatomicall…	2	2	$188,896.37	—	$45,931.18	$45,931.18	$45,931.18	2026-07-18
43 - 4	OTHER	Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies	4	4	—	—	$35,267.83	$83,557.78	$47,340.32	2026-07-18
912 - 4	OTHER	Musculoskeletal And Other Procedures For Multiple Significant Trauma	4	4	—	—	$51,431.83	$130,841.49	$71,284.24	2026-07-18
863 - 4	OTHER	Neonatal Aftercare	4	4	—	—	$79,087.39	$160,251.20	$99,378.34	2026-07-18
863 - 3	OTHER	Neonatal Aftercare	4	4	—	—	$40,457.90	$109,259.42	$57,658.28	2026-07-18
603 - 4	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	4	4	—	—	$91,993.26	$324,016.41	$149,999.05	2026-07-18
603 - 3	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	4	4	—	—	$52,092.35	$163,049.78	$79,831.71	2026-07-18
603 - 2	OTHER	Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition	4	4	—	—	$42,503.64	$123,359.89	$62,717.70	2026-07-18
602 - 4	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$125,775.77	$285,455.77	$165,695.77	2026-07-18
602 - 3	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$87,327.67	$241,033.77	$125,754.20	2026-07-18
602 - 2	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$69,780.17	$176,324.95	$96,416.37	2026-07-18
602 - 1	OTHER	Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$29,047.31	$51,981.12	$46,247.67	2026-07-18
608 - 4	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	4	4	—	—	$55,454.00	$153,330.72	$79,923.18	2026-07-18
608 - 3	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	4	4	—	—	$47,868.25	$149,910.22	$73,378.74	2026-07-18
608 - 2	OTHER	Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition	4	4	—	—	$33,069.80	$81,453.58	$45,165.75	2026-07-18
607 - 4	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$97,225.25	$310,392.88	$150,517.16	2026-07-18
607 - 3	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$66,658.94	$233,575.55	$108,388.09	2026-07-18
607 - 2	OTHER	Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$49,787.36	$110,145.52	$64,876.90	2026-07-18
613 - 4	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	4	4	—	—	$80,120.10	$149,711.49	$97,517.95	2026-07-18
613 - 3	OTHER	Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection	4	4	—	—	$43,295.07	$107,414.73	$59,324.99	2026-07-18
611 - 4	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	4	4	—	—	$80,862.76	$179,754.79	$105,585.77	2026-07-18
611 - 3	OTHER	Neonate Birth Weight 1500-1999 Grams With Major Anomaly	4	4	—	—	$43,124.81	$143,576.58	$68,237.75	2026-07-18
614 - 4	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	4	4	—	—	$53,458.74	$206,541.26	$91,729.37	2026-07-18
614 - 3	OTHER	Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition	4	4	—	—	$36,105.46	$160,162.35	$67,119.68	2026-07-18
612 - 4	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$63,698.56	$162,612.58	$88,427.07	2026-07-18
612 - 3	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$44,111.31	$158,392.49	$72,681.60	2026-07-18
612 - 2	OTHER	Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$30,890.58	$138,019.15	$57,672.72	2026-07-18
609 - 4	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	4	4	—	—	$201,765.88	$496,146.98	$275,361.16	2026-07-18
609 - 3	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	4	4	—	—	$69,990.65	$154,036.79	$91,002.18	2026-07-18
609 - 2	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	4	4	—	—	$45,669.36	$102,923.44	$59,982.88	2026-07-18
609 - 1	OTHER	Neonate Birth Weight 1500-2499 Grams With Major Procedure	4	4	—	—	$36,684.71	$93,363.35	$50,854.37	2026-07-18
623 - 4	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	4	4	—	—	$44,623.82	$94,672.63	$57,136.02	2026-07-18
623 - 3	OTHER	Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection	4	4	—	—	$33,561.77	$80,001.68	$45,171.75	2026-07-18
621 - 4	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	4	4	—	—	$62,468.21	$142,877.52	$82,570.54	2026-07-18
621 - 3	OTHER	Neonate Birth Weight 2000-2499 Grams With Major Anomaly	4	4	—	—	$31,438.17	$107,351.61	$50,416.53	2026-07-18
625 - 4	OTHER	Neonate Birth Weight 2000-2499 Grams With Other Significant Condition	4	4	—	—	$55,372.72	$143,487.74	$77,401.48	2026-07-18
622 - 4	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$41,307.51	$225,214.86	$87,284.35	2026-07-18
622 - 3	OTHER	Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other…	4	4	—	—	$27,703.47	$120,308.80	$50,854.80	2026-07-18
591 - 4	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	4	4	—	—	$189,899.56	$412,862.74	$245,640.36	2026-07-18
591 - 3	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	4	4	—	—	$143,217.17	$245,309.97	$168,740.37	2026-07-18
591 - 2	OTHER	Neonate Birth Weight 500-749 Grams Without Major Procedure	4	4	—	—	$122,839.35	$179,911.44	$137,107.37	2026-07-18
593 - 4	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	4	4	—	—	$166,958.36	$430,573.09	$232,862.04	2026-07-18
593 - 3	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	4	4	—	—	$122,135.19	$333,471.28	$174,969.21	2026-07-18
593 - 2	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	4	4	—	—	$98,236.57	$226,168.77	$130,219.62	2026-07-18
593 - 1	OTHER	Neonate Birth Weight 750-999 Grams Without Major Procedure	4	4	—	—	$74,761.47	$205,608.40	$107,473.20	2026-07-18
588 - 4	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	4	—	—	$289,591.51	$688,447.48	$389,305.50	2026-07-18
588 - 3	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	4	—	—	$192,867.64	$421,415.15	$250,004.52	2026-07-18
588 - 2	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	4	—	—	$165,266.84	$410,206.78	$226,501.83	2026-07-18
588 - 1	OTHER	Neonate Birth Weight < 1500 Grams With Major Procedure	4	4	—	—	$141,657.41	$272,832.91	$174,451.29	2026-07-18
589 - 1	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	4	4	—	—	$134,989.72	$324,350.74	$182,329.98	2026-07-18
589 - 2	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	4	4	—	—	$134,989.72	$236,219.83	$160,297.25	2026-07-18
589 - 3	OTHER	Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational …	4	4	—	—	$134,989.72	$218,079.29	$155,762.11	2026-07-18
633 - 4	OTHER	Neonate Birth Weight > 2499 Grams With Major Anomaly	4	4	—	—	$63,531.72	$158,062.83	$87,164.50	2026-07-18
630 - 4	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	4	4	—	—	$175,994.35	$291,377.93	$204,840.24	2026-07-18
630 - 3	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	4	4	—	—	$97,012.21	$175,943.85	$116,745.12	2026-07-18
630 - 2	OTHER	Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure	4	4	—	—	$44,213.13	$93,421.80	$56,515.30	2026-07-18
631 - 4	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	4	4	—	—	$194,062.06	$340,625.56	$230,702.93	2026-07-18
631 - 3	OTHER	Neonate Birth Weight > 2499 Grams With Other Major Procedure	4	4	—	—	$57,037.72	$111,707.30	$70,705.12	2026-07-18
634 - 4	OTHER	Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma…	4	4	—	—	$38,536.22	$85,776.54	$50,346.30	2026-07-18
583 - 4	OTHER	Neonate With Ecmo	4	4	—	—	$472,816.54	$774,455.49	$548,226.28	2026-07-18
583 - 3	OTHER	Neonate With Ecmo	4	4	—	—	$269,284.70	$767,167.94	$393,755.51	2026-07-18
583 - 2	OTHER	Neonate With Ecmo	4	4	—	—	$206,760.87	$481,415.24	$275,424.46	2026-07-18
583 - 1	OTHER	Neonate With Ecmo	4	4	—	—	$185,593.33	$361,417.39	$229,549.35	2026-07-18
50 - 4	OTHER	Non-bacterial Infections Of Nervous System Except Viral Meningitis	4	4	—	—	$32,564.99	$87,324.30	$46,254.82	2026-07-18
325 - 4	OTHER	Non-elective Or Complex Knee Joint Replacement	4	4	—	—	$33,275.14	$97,366.01	$49,297.86	2026-07-18
952 - 4	OTHER	Non-extensive O.r. Procedure Unrelated To Principal Diagnosis	4	4	—	—	$32,624.03	$87,794.24	$46,416.58	2026-07-18
J2350	HCPCS	Ocrelizumab 30 Mg/ml IV Soln\|discarded Drug Not Administered	14	6	$69,398.79	$41,639.27 40% off	$35,648.40	$157,164.74	$77,409.48	2026-07-18
J2351	HCPCS	Ocrelizumab-hyaluronidase-ocsq 920 Mg-23,000 Unit/23 Ml Subq Soln\|discarded Drug…	12	6	$138,752.71	$83,251.63 40% off	$86,908.72	$416,190.80	$174,590.11	2026-07-18
21 - 4	OTHER	Open Craniotomy Except Trauma	4	4	—	—	$52,662.18	$166,977.62	$81,241.04	2026-07-18
21 - 3	OTHER	Open Craniotomy Except Trauma	4	4	—	—	$37,060.31	$83,527.39	$48,677.08	2026-07-18
20 - 4	OTHER	Open Craniotomy For Trauma	4	4	—	—	$46,006.47	$130,404.29	$67,105.93	2026-07-18
20 - 3	OTHER	Open Craniotomy For Trauma	4	4	—	—	$31,765.01	$84,979.29	$45,068.58	2026-07-18
24 - 4	OTHER	Open Extracranial Vascular Procedures	4	4	—	—	$31,925.00	$99,523.98	$48,824.75	2026-07-18
681 - 4	OTHER	Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms	4	4	—	—	$47,293.29	$131,288.05	$68,291.98	2026-07-18
167 - 4	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	4	4	—	—	$59,992.96	$192,866.30	$93,211.29	2026-07-18
167 - 3	OTHER	Other Cardiothoracic And Thoracic Vascular Procedures	4	4	—	—	$38,080.19	$78,313.65	$48,138.56	2026-07-18
180 - 4	OTHER	Other Circulatory System Procedures	4	4	—	—	$32,927.77	$81,708.42	$45,122.93	2026-07-18
229 - 4	OTHER	Other Digestive System And Abdominal Procedures	4	4	—	—	$34,356.62	$116,907.01	$54,994.22	2026-07-18
283 - 4	OTHER	Other Disorders Of The Liver	4	4	—	—	$19,966.28	$123,967.77	$45,966.65	2026-07-18
98 - 4	OTHER	Other Ear, Nose, Mouth, Throat, Craniofacial, And Neck Procedures	4	4	—	—	$33,197.28	$84,827.32	$46,104.79	2026-07-18
518 - 4	OTHER	Other Female Reproductive System And Related Procedures	4	4	—	—	$34,301.00	$90,623.22	$48,381.56	2026-07-18
215	MS_DRG	Other Heart Assist System Implant	2	2	$265,522.50	—	$68,447.19	$68,447.19	$68,447.19	2026-07-18
264 - 4	OTHER	Other Hepatobiliary, Pancreas And Abdominal Procedures	4	4	—	—	$38,949.48	$122,279.74	$59,782.04	2026-07-18
447 - 4	OTHER	Other Kidney, Urinary Tract And Related Procedures	4	4	—	—	$36,595.72	$101,803.53	$52,897.67	2026-07-18
91 - 4	OTHER	Other Major Head And Neck Procedures	4	4	—	—	$53,559.70	$165,644.96	$81,581.01	2026-07-18
484 - 4	OTHER	Other Male Reproductive System And Related Procedures	4	4	—	—	$37,579.66	$88,289.89	$50,257.22	2026-07-18
320 - 4	OTHER	Other Musculoskeletal System And Connective Tissue Procedures	4	4	—	—	$31,568.22	$92,860.68	$46,891.33	2026-07-18
26 - 4	OTHER	Other Nervous System And Related Procedures	4	4	—	—	$37,349.51	$100,938.47	$53,246.75	2026-07-18
957	MS_DRG	Other O.r. Procedures For Multiple Significant Trauma With Mcc	2	2	$180,594.70	—	$52,381.31	$52,381.31	$52,381.31	2026-07-18
27 - 4	OTHER	Other Open Craniotomy	4	4	—	—	$44,321.79	$113,187.26	$61,538.16	2026-07-18
29 - 4	OTHER	Other Percutaneous Intracranial Procedures	4	4	—	—	$37,583.09	$83,978.62	$49,181.97	2026-07-18
182 - 4	OTHER	Other Peripheral Vascular And Related Procedures	4	4	—	—	$34,651.80	$143,688.80	$61,911.05	2026-07-18
405 - 4	OTHER	Other Procedures For Endocrine, Nutritional And Metabolic Disorders	4	4	—	—	$39,025.63	$142,323.41	$64,850.07	2026-07-18
651 - 4	OTHER	Other Procedures Of Blood And Blood-forming Organs	4	4	—	—	$40,605.06	$105,923.09	$56,934.57	2026-07-18
121 - 4	OTHER	Other Respiratory And Chest Procedures	4	4	—	—	$39,706.68	$136,211.88	$63,832.98	2026-07-18
309 - 4	OTHER	Other Significant Hip And Femur Surgery	4	4	—	—	$33,837.27	$102,203.33	$50,928.79	2026-07-18
223 - 4	OTHER	Other Small And Large Bowel Procedures	4	4	—	—	$33,063.81	$82,318.64	$45,377.52	2026-07-18
222 - 4	OTHER	Other Stomach, Esophageal And Duodenal Procedures	4	4	—	—	$34,605.60	$113,465.48	$54,320.57	2026-07-18
6 - 4	OTHER	Pancreas Transplant	4	4	—	—	$98,364.05	$293,603.70	$147,173.96	2026-07-18
6 - 3	OTHER	Pancreas Transplant	4	4	—	—	$75,805.30	$232,441.62	$114,964.38	2026-07-18
6 - 2	OTHER	Pancreas Transplant	4	4	—	—	$65,352.44	$190,935.11	$96,748.11	2026-07-18
6 - 1	OTHER	Pancreas Transplant	4	4	—	—	$45,393.00	$158,609.92	$73,697.23	2026-07-18
J9266	HCPCS	Pegaspargase 750 Units/ml Inj Soln\|discarded Drug Not Administered	14	6	$85,995.73	$51,597.44 40% off	$56,848.12	$257,706.36	$113,893.90	2026-07-18
510 - 4	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	1	1	—	—	$119,686.90	$119,686.90	$119,686.90	2026-07-18
510 - 3	OTHER	Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Proced…	1	1	—	—	$72,821.69	$72,821.69	$72,821.69	2026-07-18
483 - 4	OTHER	Penis, Testes And Scrotal Procedures	4	4	—	—	$34,114.48	$78,404.83	$45,187.07	2026-07-18
175 - 4	OTHER	Percutaneous Cardiac Intervention Without Ami	4	4	—	—	$36,947.37	$108,431.76	$54,818.47	2026-07-18
30 - 4	OTHER	Percutaneous Intracranial And Extracranial Vascular Procedures	4	4	—	—	$40,172.13	$113,949.44	$58,616.46	2026-07-18
183 - 4	OTHER	Percutaneous Structural Cardiac Procedures	4	4	—	—	$58,328.82	$173,704.05	$87,172.63	2026-07-18
183 - 3	OTHER	Percutaneous Structural Cardiac Procedures	4	4	—	—	$42,384.71	$97,010.63	$56,041.19	2026-07-18
183 - 2	OTHER	Percutaneous Structural Cardiac Procedures	4	4	—	—	$33,975.02	$85,236.47	$46,790.38	2026-07-18
224 - 4	OTHER	Peritoneal Adhesiolysis	4	4	—	—	$32,553.01	$85,026.05	$45,671.27	2026-07-18
170 - 4	OTHER	Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock	4	4	—	—	$40,141.33	$108,964.83	$57,347.21	2026-07-18
171 - 4	OTHER	Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock	4	4	—	—	$32,642.85	$86,622.90	$46,137.86	2026-07-18
711 - 4	OTHER	Post-operative, Post-trauma, Other Device Infections With O.r. Procedure	4	4	—	—	$37,837.20	$95,925.80	$52,359.35	2026-07-18
J9307	HCPCS	Pralatrexate 40 Mg/2 Ml (20 Mg/ml) IV Soln\|discarded Drug Not Administered	28	6	$48,052.31	$28,831.39 40% off	$15,705.16	$143,876.09	$47,602.96	2026-07-18
850 - 4	OTHER	Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal…	4	4	—	—	$52,736.62	$155,900.18	$78,527.51	2026-07-18
403 - 4	OTHER	Procedures For Obesity	4	4	—	—	$38,451.52	$94,207.37	$52,390.48	2026-07-18
130 - 4	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	4	4	—	—	$46,813.30	$112,997.88	$63,359.44	2026-07-18
130 - 3	OTHER	Respiratory System Diagnosis With Ventilator Support > 96 Hours	4	4	—	—	$35,315.75	$82,150.31	$47,024.39	2026-07-18
870	MS_DRG	Septicemia Or Severe Sepsis With Mv >96 Hours	2	2	$177,414.89	—	$47,513.64	$47,513.64	$47,513.64	2026-07-18
315 - 4	OTHER	Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement	4	4	—	—	$33,321.34	$86,344.68	$46,577.18	2026-07-18
300 - 4	OTHER	Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical	3	3	—	—	$50,944.99	$50,944.99	$50,944.99	2026-07-18
9273	OTHER	Sipuleucel-t Auto Cd54+	2	2	—	—	$54,123.65	$54,123.65	$54,123.65	2026-07-18
361 - 4	OTHER	Skin Graft For Skin And Subcutaneous Tissue Diagnoses	4	4	—	—	$45,927.75	$123,086.35	$65,217.40	2026-07-18
312 - 4	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	4	4	—	—	$47,204.31	$134,474.75	$69,021.92	2026-07-18
312 - 3	OTHER	Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses	4	4	—	—	$28,986.02	$95,320.26	$45,569.58	2026-07-18
J1747	HCPCS	Spesolimab-sbzo 60 Mg/ml IV Soln	8	6	$85,948.33	$51,569.00 40% off	$16,330.18	$128,922.49	$49,734.21	2026-07-18
321 - 4	OTHER	Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures	4	4	—	—	$41,178.32	$112,696.28	$59,057.81	2026-07-18
456	MS_DRG	Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Ex…	2	2	$171,384.22	—	$57,767.31	$57,767.31	$57,767.31	2026-07-18
23 - 4	OTHER	Spinal Procedures	4	4	—	—	$48,016.27	$149,444.96	$73,373.44	2026-07-18
650 - 4	OTHER	Splenic Procedures	4	4	—	—	$36,143.97	$96,907.76	$51,334.92	2026-07-18
J9269	HCPCS	Tagraxofusp-erzs 1000 Mcg/ml IV Soln\|discarded Drug Not Administered	12	5	$113,609.58	$68,165.75 40% off	$71,386.00	$340,547.89	$153,504.60	2026-07-18
317 - 4	OTHER	Tendon, Muscle And Other Soft Tissue Procedures	4	4	—	—	$30,218.94	$102,060.71	$48,179.38	2026-07-18
J3101	HCPCS	Tenecteplase 50 Mg IV Solr\|discarded Drug Not Administered	32	6	$27,923.79	$16,754.27 40% off	$17,222.12	$167,407.75	$54,726.82	2026-07-18
J3241	HCPCS	Teprotumumab-trbw 500 Mg IV Solr\|discarded Drug Not Administered	14	6	$55,088.69	$33,053.21 40% off	$35,919.20	$165,198.73	$73,121.20	2026-07-18
404 - 4	OTHER	Thyroid, Parathyroid And Thyroglossal Procedures	4	4	—	—	$38,559.33	$106,414.07	$55,523.01	2026-07-18
J3245	HCPCS	Tildrakizumab-asmn 100 Mg/ml Subq Syr\|discarded Drug Not Administered	16	6	$46,799.29	$28,079.57 40% off	$34,709.00	$217,623.48	$91,510.31	2026-07-18
9194	OTHER	Tisagenlecleucel Car-pos T	2	2	—	—	$551,234.37	$551,234.37	$551,234.37	2026-07-18
4	MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	2	2	$320,417.42	—	$95,218.38	$95,218.38	$95,218.38	2026-07-18
4 - 4	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	4	4	—	—	$152,101.72	$320,168.06	$194,118.30	2026-07-18
4 - 3	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	4	4	—	—	$104,885.44	$212,124.40	$131,695.18	2026-07-18
4 - 2	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	4	4	—	—	$67,025.99	$153,538.80	$88,654.19	2026-07-18
4 - 1	OTHER	Tracheostomy With Mv >96 Hours With Extensive Procedure	4	4	—	—	$46,371.81	$119,584.02	$64,674.86	2026-07-18
5 - 4	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	4	4	—	—	$105,960.07	$302,336.13	$155,054.08	2026-07-18
5 - 3	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	4	4	—	—	$76,897.91	$214,090.66	$111,196.10	2026-07-18
5 - 2	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	4	4	—	—	$51,274.40	$123,834.51	$69,414.43	2026-07-18
5 - 1	OTHER	Tracheostomy With Mv >96 Hours Without Extensive Procedure	4	4	—	—	$26,929.15	$104,520.29	$46,326.93	2026-07-18
5244	OTHER	Transplt Allo Hct/donor	2	2	—	—	$57,637.75	$57,637.75	$57,637.75	2026-07-18
J3316	HCPCS	Triptorelin Pamoate(pediatric) 22.5 Mg IM Susr\|discarded Drug Not Administered	14	6	$75,107.70	$45,064.62 40% off	$91,614.64	$408,687.54	$181,226.56	2026-07-18
J2329	HCPCS	Ublituximab-xiiy 25 Mg/ml IV Soln\|discarded Drug Not Administered	14	6	$37,374.49	$22,424.69 40% off	$21,225.90	$112,056.14	$47,836.71	2026-07-18
519 - 4	OTHER	Uterine And Adnexa Procedures For Leiomyoma	4	4	—	—	$33,593.42	$93,683.66	$48,615.98	2026-07-18
512 - 4	OTHER	Uterine And Adnexa Procedures For Non-ovarian And Non-adnexal Malignancy	4	4	—	—	$39,690.43	$98,046.37	$54,279.42	2026-07-18
511 - 4	OTHER	Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy	4	4	—	—	$41,488.04	$114,753.72	$59,804.46	2026-07-18
3060	EAPG	Ventricular Assist Device Procedures	4	4	—	—	$42,925.84	$52,563.06	$45,335.14	2026-07-18
22 - 4	OTHER	Ventricular Shunt Procedures	4	4	—	—	$41,151.79	$108,836.24	$58,072.90	2026-07-18
1643	OTHER	Y90 Ibritumomab, Rx	2	2	—	—	$55,378.93	$55,378.93	$55,378.93	2026-07-18

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